Australia’s Stronger Rural Health Strategy fails to address the Doctor Drought

Australia’s rural and remote communities face significant healthcare disadvantage when compared to major cities. Critical workforce shortages, inaccessibility to healthcare services, and increased rates of risk-taking behaviours are all major contributors to this health inequity. In an attempt to address this issue, the Department of Health introduced the Stronger Rural Health Strategy with the aim of redistributing 3000 doctors and 3000 nurses to underserved areas by 2028.

Despite receiving funding of over 250 million dollars annually, the Stronger Rural Health Strategy has failed to adequately address the rural health crisis. The strategy encompasses various programs and initiatives including: International Medical Graduate (IMG) restrictions; The Visas for GPs Program; Bonded Medical Program; HELP debt reduction scheme; and the Workforce Incentive Program. Although these programs have shown some efficacy in recruiting doctors through obligatory rural service, they fail to ensure long term retention. This is evident in the consistent departure of IMGs from rural areas following the completion of their obligatory rural period ; the high buy-out rate of participants in the Bonded Medical Program, with only 4.4% of participants having completed their rural service; and the limited effectiveness of financial incentives in retaining doctors long-term. The long-term effectiveness of the Stronger Rural Health Strategy is called into question by these findings, as it appears to offer temporary solutions to a long-term problem. The strategy fails to address the fundamental factors that discourage practitioners from working in rural areas, such as inadequate opportunities for career progression; professional and personal isolation; and reduced employment and education opportunities for partners and children. Therefore, it is crucial that future recruitment and retention strategies address these determinants and provide sustainable, long-term solutions.  

So, what works? Rural entry schemes, immersion opportunities, and training pathways have all consistently demonstrated efficacy in promoting rural retention. Students who attend Rural Clinical School (RCS) programs for instance, are 2.6 times more likely to pursue rural practice. It is important to note that the Stronger Rural Health Strategy includes only two initiatives that align with these evidence-based approaches: the Murray-Darling Medical Schools Network and the Junior Doctor Training Program. Both programs embrace the concept of voluntary rural training, an approach that has shown to be effective throughout the literature. To address the maldistribution and inequitable delivery of healthcare across the country,  governments and education providers should prioritise and expand initiatives of this nature. For example, enhancing the availability of Rural Clinical Schools, expanding post-graduate rural training opportunities, mandating medical school Rural Entry Schemes, and replacing obligatory service strategies with voluntary rural immersion programs are all promising measures to enhance workforce retention.

What can we as students do? The onus of this issue doesn’t just lie with policy makers and education providers, future doctors need to be a part of the solution. With this in mind, I encourage prospective and current medical students to venture beyond their comfort zones and embrace purpose built rural training programs such as Deakin’s Rural Training Stream. By actively seeking firsthand experience in rural healthcare, we can challenge and dispel the misconceptions that often surround rural practice. It is through these concerted actions that we can effectively confront the nations critical rural workforce shortage.

Emma Wylie is a final year Deakin medical student (2023) whose clinical studies have been in Horsham and Warrnambool. She possesses a deep-rooted appreciation for rural communities and is driven to advocate for the numerous career and lifestyle prospects they offer.

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